The NHS spends around £6.5 billion every year treating obesity. People who are overweight cost the health service twice as much as those who maintain a healthy weight. Half of all cancer cases are linked to obesity and being severely overweight significantly increases the risk of other conditions, such as diabetes, strokes and heart attacks. No public health campaign or intervention has ever worked. Obesity rates have nearly doubled in the UK since the 1990s. More than 60 per cent of adults are overweight.
It’s hoped that weight-loss injections, known as GLP-1 agonists – semaglutide (also known as Wegovy or Ozempic) and the more recent market entry tirzepatide (Mounjaro) – could reverse this trend. Rishi Sunak announced last month that he’s committed to rolling out these drugs – which were originally developed to treat type 2 diabetes – on the NHS to tackle the nation’s ill health. Until now, weight-loss injections have been restricted to pilot programmes on the health service; most patients taking these drugs get them privately. The Treasury is said to be supportive of the roll-out, but can the nation really afford them?
In 2022, semaglutide accounted for a staggering 8 per cent of all Denmark’s medicine costs
Other countries provide a warning. Wegovy is only available in a handful of European nations, such as Germany, Denmark, the UK and Switzerland. Everywhere demand outstrips supply. Last month, the Danish government, where the manufacturer of Wegovy and Ozempic is based, announced that it would restrict prescriptions for Ozempic and will start putting patients with type 2 diabetes on cheaper drugs first. This came after the bill for the GLP-1 agonists topped $200 million last year, double 2022’s expenditure. In total, it accounted for a staggering 8 per cent of all Denmark’s medicine costs.
In the US, a report published last month by the Senate’s Health, Education, Labor and Pensions Committee claimed high GLP-1 drug prices, coupled with high uptake, could ‘bankrupt our entire health-care system’. The report warned that if half the adults with obesity in the US start taking Wegovy or similar drugs, total spending on these medications could reach $411 billion – more than Americans spent on retail prescription drugs in 2022. In an attempt to cure obesity, could we end up killing the NHS?
Don’t get me wrong, I’m a fan of these drugs. I first came across patients taking Ozempic off-licence around seven years ago while working in a specialist service assessing patients for bariatric surgery. Many were ineligible for the surgery, so we could offer them little except advice on diet and exercise. Then, suddenly, patients started telling me about semaglutide, which they were getting privately. Their physical transformations were extraordinary. But as more people discovered the drug, diabetics started struggling to get hold of it. When Wegovy was released last year, it meant stocks of Ozempic could be ring-fenced for diabetics so this was no longer a concern.
It isn’t only obesity and diabetes that semaglutide can be used to treat. A study published last month showed that if patients take the drug for more than three years, they’ll cut the risk of heart attack, stroke or cardiac death by 20 per cent. The effect is similar to that of statins, but over a much shorter time frame.
Yet however evangelical I am about the potential benefits of these drugs, unless their prescription is carefully managed, the NHS will be overwhelmed. What happens when more than half the population are eligible for a drug that will cost thousands of pounds a year for each person? For one, it would require considerable additional, ring-fenced funding, or risk draining money from other services. What’s more, if it’s dished out for ‘free’, there will be little incentive to try to lose weight any other way. In fact, why bother with any self-control at all, when all the problems can be overcome when you want with a quick jab that won’t cost you a penny?
I’ve seen from my patients, who tend to be in their fifties and older, that they have tried various ways of losing weight before turning to medication. They have made an active decision to invest in their long-term health and they are determined to make it work. Wegovy and Mounjaro still require you to embrace lifestyle changes. They only work when combined with reduced calorie intake and exercise. Yes, they reduce your appetite, but they aren’t miraculous – people still need to put the work in.
There’s a bigger question too. To what extent can obesity be considered a ‘lifestyle’ issue, as it is in Germany? There are those in medicine who wholeheartedly believe that, like addiction, obesity is a disease. But this is counter-productive. People struggling with their weight deserve our compassion. The idea that obesity is an illness, however, removes any semblance of personal responsibility and flies in the face of much of the psychological work that’s done with overweight patients to help them make changes to their lives.
Obesity is the result of a behaviour: it isn’t pathology, it’s the body doing what it is supposed to do when more energy is consumed than expended. So if we don’t think it’s a disease, is it right that the NHS gets involved? Isn’t this yet more mission-creep into the realm of personal responsibility for our wellbeing?
The NHS undertakes all sorts of rationing. In all but a few cases, it doesn’t fund cosmetic breast enhancement or nose jobs. It rarely funds medication for hair loss. It limits IVF. In a utopia, everyone would get everything they want from the NHS. This isn’t feasible. If the health service is going to survive for future generations, we need to decide where the limits of its responsibilities lie.
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